Efficacy of a Supplemental Small-Group Early Literacy Intervention Implemented by Early Childhood Educators.

PURPOSE: Phonological awareness and alphabet knowledge are fundamental building blocks for literacy development. We identified preschoolers with persistent delays in these skills and evaluated the efficacy of a supplemental curriculum to remediate deficits in early literacy skills. METHOD: Using a cluster design, 21 classrooms were randomly assigned to early literacy versus language intervention conditions. Sixty children identified through fall semester assessments of phonological awareness and alphabet knowledge were enrolled in small-group instruction. Teachers completed eLearning modules, used a digital platform to enter data and facilitate data-based decision making, received practice-based coaching, and delivered 12 weekly units of an early literacy curriculum. Comparison teachers delivered similarly administered small-group language instruction. RESULTS: Large effects were evident for letter sounds, phoneme segmentation, first sound, and first sound fluency measures (d = 0.92, 4.77, 1.15, and 1.50, respectively), and nonsignificant, small effects for letter naming and blending measures (d = 0.26 and 0.27). DISCUSSION: This early literacy intervention package had practical benefits, with 90% of experimental group preschoolers exceeding the phonemic awareness benchmark for beginning kindergarten compared to 45% in the comparison group, for example. Providing preschool teachers with tools and support for implementing a tiered approach to early literacy intervention holds promise for producing impressive gains in skills required for children to succeed in later schooling.

Using Multivariate Adaptive Regression Splines to Predict Lexical Characteristics' Influence on Word Learning in First Through Third Graders.

PURPOSE: Identifying appropriate targets for vocabulary instruction and determining the optimal sequence for instruction continue to be a challenge. The purpose of this study is to investigate how previously studied lexical characteristics collectively influence children's word learning. METHOD: A secondary data analysis was conducted using the word learning results of 350 first-, second-, and third-grade students who participated in an investigation examining the effects of a supplemental vocabulary intervention. We investigated the influence of the following lexical characteristics on the learning of 377 words: word frequency, level of concreteness, phonotactic probabilities, neighborhood density, and age of acquisition using multivariate adaptive regression splines (MARS). RESULTS: MARS modeled the influence lexical characteristics had on word learning and determined the relative importance of each variable for each grade-level model. Results revealed age of acquisition was the most important factor related to word learning in all grades, but contributions of other lexical characteristics and their level of importance differed across models. All respective models fit well, with root-mean-square error values ranging from 0.11 to 0.15 and generalized cross validation scores of 0.01 and 0.03. CONCLUSIONS: Nuanced information from the MARS analysis provides insights into how lexical characteristics affect word learning differently for children in different grade levels. This information is key to understanding the vocabulary acquisition of school-aged children. The findings from this research have the potential to inform the development of a word selection framework that will organize vocabulary targets into an appropriate sequence based on relevant predictors. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21899529.

A Latent Profile Analysis to Categorize and Describe Athletes Based on Factors Related to Concussion Disclosure.

CONTEXT: Collegiate student-athletes continue competing after experiencing symptoms of a concussion. Self-report of concussion symptoms is a critical element of the recovery process. Identifying factors related to concussion disclosure can aid in encouraging self-reporting. OBJECTIVE: To use latent profile analysis to categorize and describe athletes based on factors related to concussion disclosure. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 2 881 (52.4% female; 65.3% in-season; 40% collision sport) student-athletes from 16 National Collegiate Athletic Association member institutions. MAIN OUTCOME MEASURE(S): Student-athlete concussion expectations, attitudes, and norms were the profile variables and reporting intentions served as the distal outcome variable. We conducted latent profile analysis using select profile variables to determine the optimal number of classes. Differences in concussion-reporting intentions by profile assignment were then examined. Lastly, the extent to which a student-athlete's sex, season status, and level of contact predicted his or her intentions to report a concussion within each profile was investigated. RESULTS: Five unique student-athlete profiles emerged, including 1 profile that was most risky and another that was least risky. Females had significantly higher odds of being in the least risky profile. Those participating in collision sports had significantly higher odds of being in the top 2 most risky profiles. Contact-sport and in-season athletes were less likely to be in the least risky profile. CONCLUSIONS: With a better understanding of student-athlete profiles, athletic trainers have an opportunity to encourage concussion disclosure. Prompt disclosure would allow student-athletes to begin the return-to-play protocol in a more timely manner.

Feasible Implementation Strategies for Improving Vocabulary Knowledge of High-Risk Preschoolers: Results From a Cluster-Randomized Trial.

Purpose Many children begin school with limited vocabularies, placing them at a high risk of academic difficulties. The goal of this study was to examine the effects of a vocabulary intervention program, Story Friends, designed to improve vocabulary knowledge of at-risk preschool children. Method Twenty-four early-childhood classrooms were enrolled in a cluster-randomized design to evaluate the effects of a revised Story Friends curriculum. In each classroom, three to four preschoolers were identified as having poor language abilities, for a total of 84 participants. In treatment classrooms, explicit vocabulary instruction was embedded in prerecorded storybooks and opportunities for review and practice of target vocabulary were integrated into classroom and home practice activities. In comparison classrooms, prerecorded storybooks included target vocabulary, but without explicit instruction, and classroom and home strategies focused on general language enrichment strategies without specifying vocabulary targets to teach. Intervention activities took place over 13 weeks, and 36 challenging, academically relevant vocabulary words were targeted. Results Children in the treatment classrooms learned significantly more words than children in the comparison classrooms, who learned few target words based on exposure. Large effect sizes (mean d = 1.83) were evident as the treatment group averaged 42% vocabulary knowledge versus 11% in the comparison group, despite a gradual decline in vocabulary learning by the treatment group over the school year. Conclusions Findings indicate that a carefully designed vocabulary intervention can produce substantial gains in children's vocabulary knowledge. The Story Friends program is feasible for delivery in early childhood classrooms and effective in teaching challenging vocabulary to high-risk preschoolers. Supplemental Material https://doi.org/10.23641/asha.13158185.

Using the Integrated Behavioral Model to Determine Sport-Related Concussion Reporting Intentions Among Collegiate Athletes.

PURPOSE: A significant proportion of sport-related concussions goes unreported among adolescents, which can result in irreversible brain damage. It is critical to identify and intervene on factors that significantly impact concussion reporting. METHODS: This study tests factors associated with collegiate athletes' intentions to (1) self-report concussion symptoms; (2) report another athlete's concussion symptoms; and (3) encourage others to report. Drawing on the Integrated Behavioral Model, predictors at the athlete level included perceived norms (bystander descriptive norms, injunctive norms, and subjective norms), attitudes (positive and negative expectancies about reporting and playing through a concussion and concussion reporting attitudes), personal agency (self-efficacy to recognize symptoms and communicate), and perceived coach communication. At the team level, coaches' self-reported communication was also included. Athletes (N = 1,858) and coaches (N = 254) at 16 colleges and universities completed Web-based surveys in 2016. Multilevel modeling accounted for the nesting of athletes within athletic team. RESULTS: Bystander descriptive norms, positive reporting expectancies, concussion reporting attitudes, self-efficacy to communicate about a concussion, and athletes' perceptions of their coach's communication were positively associated with all three outcomes. By contrast, subjective norms were only positively associated with intentions to self-report and bystander reporting intentions, negative reporting expectancies were only associated with intentions to self-report, and positive and negative expectancies for playing through a concussion were only associated with intentions to self-report and bystander encouragement. CONCLUSIONS: In sum, multiple factors within the Integrated Behavioral Model predict reporting intentions and underscore the complexity of athletes' concussion reporting behaviors and offer guidance for the development of prevention strategies.

Iterative Development of a Home Review Program to Promote Preschoolers' Vocabulary Skills: Social Validity and Learning Outcomes.

Purpose This article describes the iterative development of a home review program designed to augment vocabulary instruction for young children (ages 4 and 5 years) occurring at school through the use of a home review component. Method A pilot study followed by two experiments used adapted alternating treatment designs to compare the learning of academic words taught at school to words taught at school and reviewed at home. At school, children in small groups were taught academic words embedded in prerecorded storybooks for 6 weeks. Children were given materials such as stickers with review prompts (e.g., "Tell me what brave means") to take home for half the words. Across iterations of the home intervention, the home review component was enhanced by promoting parent engagement and buy-in through in-person training, video modeling, and daily text message reminders. Visual analyses of single-subject graphs, multilevel modeling, and social validity measures were used to evaluate the additive effects and feasibility of the home review component. Results Social validity results informed each iteration of the home program. The effects of the home program across sites were mixed, with only one site showing consistently strong effects. Superior learning was evident in the school + home review condition for families that reviewed words frequently at home. Although the home review program was effective in improving the vocabulary skills of many children, some families had considerable difficulty practicing vocabulary words. Conclusion These studies highlight the importance of using social validity measures to inform iterative development of home interventions that promote feasible strategies for enhancing the home language environment. Further research is needed to identify strategies that stimulate facilitators and overcome barriers to implementation, especially in high-stress homes, to enrich the home language environments of more families.

Classwide Extensions of Vocabulary Intervention Improve Learning of Academic Vocabulary by Preschoolers.

Purpose Many preschoolers, especially those from low-income households, would benefit from instruction to enrich their vocabulary and language repertoires. Yet, explicit instruction of vocabulary and language skills generally occurs infrequently in early childhood education settings. This study investigated the additive effects of teacher-led, classwide review strategies to a previously studied small-group intervention on children's learning of academic vocabulary. Method Participants included 23 children with limited oral language skills at risk for reading difficulties enrolled in single-case experimental designs. Effects of the classroom strategies alone also were examined in 10 children with above-average language abilities from 2 classrooms. Results Visual analyses of the adapted alternating treatments designs showed consistent learning improvements when vocabulary instruction was extended into the classroom for 12 children, ceiling effects were evident for 3 participants regardless of condition, and inconsistent or minimal effects were demonstrated by 8 participants. Multilevel modeling used to evaluate the effects statistically revealed strong treatment effects. In addition, the 10 children with above-average language showed impressive learning of vocabulary words from books subject to teacher review strategies in comparison to words from books to which they were not exposed. Teachers varied in the extent to which they implemented review strategies in their classrooms. Nevertheless, their responses to social validity assessments were positive, supporting the feasibility of this intervention. Conclusions The addition of classwide review and practice opportunities is an effective means of enhancing the effects of an easy-to-implement small-group intervention that teaches challenging vocabulary words within prerecorded stories. This approach holds promise as a way to shrink the pervasive word gap that typically exists when children in high-poverty communities enter school.

Moving Forward Four Words at a Time: Effects of a Supplemental Preschool Vocabulary Intervention.

Purpose This study evaluated the effects of an automated, small-group intervention designed to teach preschoolers challenging vocabulary words. Previous studies have provided evidence of efficacy. In this study, we evaluated the effects of the program after doubling the number of words taught from 2 to 4 words per book. Method Seventeen preschool children listened to 1 prerecorded book per week for 9 weeks. Each storybook had embedded, interactive lessons for 4 target vocabulary words. Each lesson provided repeated exposures to words and their definitions, child-friendly contexts, and multiple opportunities for children to respond verbally to instructional prompts. Participants were asked to define the weekly targeted vocabulary before and after intervention. A repeated acquisition single-case design was used to examine the effects of the books and embedded lessons on learning of target vocabulary words. Results Treatment effects were observed for all children across many of the books. Learning of at least 2 points (i.e., 1 word) was replicated for 74.5% of 149 books tested across the 17 participants. On average, children learned to define 47% of the target vocabulary words (17 out of 36). Conclusions Results support including 4 challenging words per book, as children learned substantially more words when 4 words were taught, in comparison to previous studies. Within an iterative development process, results of the current study take us 1 step closer to creating an optimal vocabulary intervention that supports the language development of at-risk children.

Mechanical characterization of a bifunctional Tetronic hydrogel adhesive for soft tissues.

Although a number of tissue adhesives and sealants for surgical use are currently available, attaining a useful balance in high strength, high compliance, and low swelling has proven difficult. Recent studies have demonstrated that a four-arm poly(propylene oxide)-poly(ethylene oxide) block copolymer, Tetronic, can be chemically modified to form a hydrogel tissue adhesive (Cho et al., Acta Biomater 2012;8:2223-2232; Barrett et al., Adv Health Mater 2012;1-11; Balakrishnan, Evaluating mechanical performance of hydrogel-based adhesives for soft tissue applications. Clemson University, All Theses, Paper 1574: Tiger Prints; 2013). Building on the success of these studies, this study explored bifunctionalization of Tetronic with acrylates for chemical crosslinking of the hydrogel and N-hydroxysuccinimide (NHS) for reaction with tissue amines. The adhesive bond strengths of various uni and bifunctional Tetronic blends (T1107 ACR: T1107 ACR/NHS) determined by lap shear testing ranged between 8 and 74 kPa, with the 75:25 (T1107 ACR: T1107 ACR/NHS) blend displaying the highest value. These results indicated that addition of NHS led to improvement of tissue bond strength over acrylation alone. Furthermore, ex vivo pressure tests using the rat bladder demonstrated that the bifunctional Tetronic adhesive exhibited high compliance and maintained pressures under hundreds of filling and emptying cycles. Together, the results of this study provided evidence that the bifunctional Tetronic adhesive with a proper blend ratio may be used to achieve an accurate balance in bulk and tissue bond strengths, as well as the compliance and durability for soft tissue such as the bladder.

A PLCγ1-dependent, force-sensitive signaling network in the myogenic constriction of cerebral arteries.

Maintaining constant blood flow in the face of fluctuations in blood pressure is a critical autoregulatory feature of cerebral arteries. An increase in pressure within the artery lumen causes the vessel to constrict through depolarization and contraction of the encircling smooth muscle cells. This pressure-sensing mechanism involves activation of two types of transient receptor potential (TRP) channels: TRPC6 and TRPM4. We provide evidence that the activation of the γ1 isoform of phospholipase C (PLCγ1) is critical for pressure sensing in cerebral arteries. Inositol 1,4,5-trisphosphate (IP3), generated by PLCγ1 in response to pressure, sensitized IP3 receptors (IP3Rs) to Ca(2+) influx mediated by the mechanosensitive TRPC6 channel, synergistically increasing IP3R-mediated Ca(2+) release to activate TRPM4 currents, leading to smooth muscle depolarization and constriction of isolated cerebral arteries. Proximity ligation assays demonstrated colocalization of PLCγ1 and TRPC6 with TRPM4, suggesting the presence of a force-sensitive, local signaling network comprising PLCγ1, TRPC6, TRPM4, and IP3Rs. Src tyrosine kinase activity was necessary for stretch-induced TRPM4 activation and myogenic constriction, consistent with the ability of Src to activate PLCγ isoforms. We conclude that contraction of cerebral artery smooth muscle cells requires the integration of pressure-sensing signaling pathways and their convergence on IP3Rs, which mediate localized Ca(2+)-dependent depolarization through the activation of TRPM4.

Clinical applications of surgical adhesives and sealants.

In the United States and Europe, the number of topical adhesives, surgical sealants, and hemostats approved for use in the surgical setting is ever expanding although no single device fills all medical and surgical needs to replace sutures. As more surgical procedures are performed through laparoscopic and robotic approaches, these devices are becoming more important, and current research is focused on solving the limitations of conventional wound treatments. This review article discusses clinical applications of various biologically derived and synthetic products that are currently available to surgeons and those that are in development.